VBAC as a Hospital Quality Indicator: Linking Hospital Organizational and Clinical Factors on L&D to Delivery Outcome. VBAC is a common indicator used to monitor maternal health care quality and hospital performance. There is marked variation in VBAC rates, yet little is known about the specific hospital organizational factors and L&D clinical factors that contribute to this variation. Given recent concern about the relative safety of VBAC it is important to characterize the specific factors associated with safe VBAC rates for both mothers and babies. This project has 4 study aims: 1) To validate and administer a survey instrument designed to identify hospital specific organizational factors and L&D clinical policies associated with utilization of VBAC; 2) To describe the existing variation in hospital specific organizational factors, clinical policies, and case mix; 3) To assess the relationship of hospital specific organizational factors and L&D clinical policies with utilization of VBAC (primary study outcomes: repeat cesarean, attempted VBAC and successful VBAC); 4) To assess the relationship of hospital specific organizational factors and L&D clinical policies with maternal and neonatal outcomes (secondary study outcomes) stratifying by type of delivery for women with a history of prior cesarean delivering in California hospitals during the proposed study year (2003). This is a 2-part study. Primary survey data obtained from structured interviews with L&D nurse managers will elicit information about hospital organizational factors and L&D clinical factors believed to be associated with VBAC outcome. The survey responses will be merged with population based administrative data that includes linked maternal and neonatal hospital discharge data and vital statistics data. Rates for the primary and selected secondary outcomes will be calculated. It is hypothesized that hospital specific organizational and clinical factors vary among hospitals in California, and that these factors are related to VBAC outcomes. These factors will be used to develop models that predict which hospital organizational factors and clinical polices are associated with safe VBAC utilization. By linking hospital organizational factors and clinical polices to patient outcomes, this information could serve as the basis for the development of evidenced-based policy recommendations regarding "best practices" to promote safe VBAC utilization in different hospital settings.